The decedent in this case was an inmate who was sent to Cook County Jail as a pretrial detainee. About a month later, he started to develop severe pains in his back and abdomen. The jail responded to his complaints and sent him to an outside medical facility where it was determined that a "paratracheal tumor" was growing in his chest. The physician assistant urged "urgent" pulmonary consultation.

For some reason there was delay in receiving his care. Dixon's health deteriorated at an aggressive rate. One day he lay on the ground of this cell panting, unable to use the toilet, and having a reduced ability to move his legs. The attendant nurse took no action. In fact, despite the fact his tumors were by now documented, another physician's assistant thought that Dixon was faking his pain and ordered a psychiatric consultation instead of a physical intervention. Things quickly went down from there. Weeks later, Dixon was dead -- officially killed by lung cancer.

"Moving Force"

Dixon's mother brought a wrongful death suit against the jail. Her legal challenge rested entirely on the fact that it took 26 days before Dixon received palliative care from the time Dixon's jailers first became aware of his tumor. The jail's motion to dismiss and later the summary judgment motion would later be overturned by the Seventh Circuit.

The most basic reasoning went like this. Dixon's mother relied on a case called Monell v. Dep't of Soc. Servs. of New York. The case stands for the rule that when bringing a suit seeking to prove an official policy it must be proven by the plaintiff that widespread custom or action by an official with policy-making authority was the "moving force" behind the eventual injury. This "moving force" requirement was later clarified in Thomas v. Cook County Sheriff's Dept.: such a policy could "take the form of an implicit policy or gap in expressed policies." In other words, the moving force could be nothing.

The facts seemed to clearly indicate that Cook County Jail had massive problems of communication and records keeping. There was both a paper-record keeping system and an electronic record keeping system, and the two were not coordinated. Thus, even if there was no conscious intent to deny Dixon palliative care for his cancerous growths based on "malingering," the widespread deficiencies in the system would be enough for a reasonable jury to conclude that such deficiencies were the "moving force" behind Dixon's injury and death -- thus, questions of material fact remained.

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